ABSCESSES DURING OSTEOARTICULAR BRUCELLOSIS: A STUDY OF 26 CASES

Background: Brucellosis remains an important economic and public health problem in developing countries. The osteoarticular involvement is one of it serious complication mainly due to abscess formation. Objectives: The aim of our study was to identify the frequency and radiological features of abscesses during osteoarticular brucellosis. Methods: We conducted a retrospective study including 26 patients who have been hospitalized for osteoarticular brucellosis from 1998 to 2018. The diagnosis of brucellosis was made on the basis of clinical symptoms, imaging finding (CT scan or MRI) and isolation of brucella species in blood or tissue specimens and/or a positive Wright agglutination test. Results: Twenty six patients were included. 15 patients were male. The mean age was 52 years [21-77].the geographical origin of the patients was rural in 80% of the cases. The average duration of symptoms progression was 4.76 months [1-12]. Prominent clinical symptoms were inflammatory pain (all cases), fever (in 21 cases) and sweating (in 17 cases). Weight loss was found in 11 cases (42.8%) and hepatomegaly was found in 1 patient. The physical examination revealed a paresis of the two lower limbs in 2 cases. Brucella agglutination test was ≥1/160 in all cases (mean 1/760). Blood cultures were negative in all cases. Erythrocyte sedimentation rate (ESR) and serum C-reactive protein level were ranged 2-108 mm (mean 41.37 mm) and 0-125 mg/l (mean 30 mg/l) respectively. Leucopenia was found in only 1 case and leukocytosis in 6 cases. The most frequent osteoarticular involvement was spondylodiscitis in 20 cases (76.9%) affecting the lumbar dorsal and cervical spine in respectively 12, 6 and 2 cases. Sacroiliitis was found in 4 cases (15.4%) and septic arthritis in 2 cases (7.7%). Biopsy was performed in 8 cases, but bacteriological examination was contributory to the diagnosis in 2 cases. The radiological findings showed that 14 patients (53.8%) had abscesses. Soft tissue abscesses were detected in 7 cases with mean size of 1.3 cm [0-9cm]. Bilateral psoas abscess was recorded in one case. Epidural collection was revealed in 3 cases with an average size of 0.3 cm [0-5cm].Paravertebral and peri-vertebral abscesses were detected in 5 cases. Intradiscal abscesses were observed in 3 cases. Cord compression and involvement of root nerve were noted in respectively 6 and 1 cases.Compared to the group without abscesses, subjects with abscesses had higher ESR and the difference was statistically significant (mean ESR 26.83 vs 55.9 mm) (p=0.016). There was no statistically significant link between duration of symptoms or duration of hospitalization and the presence of abscesses. All patients had antibiotic treatment (cyclins and rifampicin). The evolution was favorable in all cases. Surgical intervention was required in one case (evacuation of an epidural abscess). Conclusion: Our study showed that abscesses are frequent in osteoarticular brucellosis.In spite of the low risk of complication, we have to screen it using a cross sectional imaging. Disclosure of Interests: None declared DOI: 10.1136/annrheumdis-2019-eular.8080Citation: Ann Rheum Dis, volume 78, supplement 2, year 2019, page A1915Session: Infection-related rheumatic diseases (Scientific Abstracts)